370802857-6-27-2023-08-AS-LTEZ-CTAN3G-20230630100618

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 370802857
Report Date: 06/27/2023
Date Signed: 06/27/2023 11:22:37 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/28/2022 and conducted by Evaluator Dawn Segura

COMPLAINT CONTROL NUMBER: 08-AS-20221128101926

FACILITY NAME:	CARROLL'S COMMUNITY CARE		FACILITY NUMBER:	370802857
ADMINISTRATOR:	ROGELIO HERNANDEZ		FACILITY TYPE:	735
ADDRESS:	523 EMERALD AVENUE		TELEPHONE:	(619) 442-8893
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92020
CAPACITY:	70	CENSUS: 68	DATE:	06/27/2023
		UNANNOUNCED	TIME BEGAN:	11:03 AM
MET WITH:	Roger Hernandez, Administrator		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Licensee did not protect client from harm while in care.

Licensee did not safeguard resident's personal property.

Client's room did not have heat.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced visit to deliver investigative findings. LPA introduced herself, was granted entry into the facility, and met with Roger Hernandez, Administrator, to whom LPA disclosed the reason for the visit.

Community Care Licensing (CCL) has investigated the allegations listed above. The investigation consisted of a tour of the facility, review of facility and outside source records, and interviews of facility staff, clients, and outside source.

It was alleged that Client 1 (C1) was not protected from harm while in care. It was reported that C1 was assaulted by another resident while at the facility, and C1 has been singled out and taken on one-on-one outings away from the facility by persons who are not associated with the facility, which puts C1 at risk.

During the course of the investigation, LPA gained information that persons from a local church took an

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 08-AS-20221128101926

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: CARROLL'S COMMUNITY CARE	FACILITY NUMBER: 370802857
	VISIT DATE: 06/27/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

interest in C1. Over time, C1 was transported from the facility to attend church or to go on other outings with the outside parties. Records maintained by the facility and reviewed during the investigation revealed that C1 has the ability to leave the facility on his/her own. Interviews conducted, including interview of C1, yielded that C1 has voluntarily chosen to go on outings with the outside parties.

In response to the report that C1 was not protected from being assaulted by another client in care, the investigation yielded that law enforcement was called and arrived at the facility on the morning of 5/1/2022, in response to an altercation in which C1 was attacked by C5. According to law enforcement records, C5’s attack on C1 was initiated because of C5’s diagnosed mental health issues. Records reflect that no injuries were sustained by C1. Records also reflect that C5 had been administered prescribed medications the morning of the incident. C5 was taken into custody and taken to a local hospital for mental health services. The investigation yielded no subsequent incidents following C5’s discharge from the hospital and return to the facility. There was no evidence obtained to conclude that C5’s attack resulted from action or lack of action on the part of facility staff.

The second allegation is that C1’s personal property was not safeguarded. Records reviewed during the investigation reflected that clients were provided notification that the licensee, administrator, and staff would not be responsible for valuables and personal property brought into the facility, unless the items were given to the licensee or administrator for safeguarding. It was further discovered, through outside source interview, that C1 was informed, during the admission process, that there would be very limited storage space available and that items of personal value should not be kept in the open. In addition to the foregoing, the investigation did not produce evidence to corroborate that items were missing or taken from C1.

The third allegation is that client’s room did not have heat. It was reported that the heater in C1’s room did not work. During a visit to the facility, a tour of the facility revealed that some client rooms within the facility did not have heat, including the room in which C1 was initially placed at the time of admission. However, it was observed, and interviews yielded that facility staff provided portable heaters and/or blankets to clients, upon request, or when staff were made aware that a client did not have sufficient heat. The investigation also yielded that C1 was provided a portable heater for use, once facility staff were made aware of C1’s discomfort.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 08-AS-20221128101926

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: CARROLL'S COMMUNITY CARE	FACILITY NUMBER: 370802857
	VISIT DATE: 06/27/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Based upon the foregoing, the investigation did not yield evidence to conclude that there were violations of Title 22 regulations. Accordingly, the allegations are unsubstantiated. This finding means that although the allegations may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

An exit interview was conducted with Roger Hernandez, and a copy of this report and Licensee/Appeal Rights (LIC 9058) were provided to the Administrator at the conclusion of the visit. His signature below serves as acknowledgment of receipt of copies of the report and rights.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3